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Title: Early experience with lateral lumbar total disc replacement: Utility, complications and revision strategies.
Epworth Authors: Malham, Gregory
Other Authors: Parker, Rhiannon
Keywords: Lumbar Total Disc Replacement
Total Disc Replacement
Spinal Surgery
Back Surgery
Lateral Approach
Revision Strategies
Symptomatic Degenerative Disc Disease
Direct Lateral Retroperitoneal, Transpsoas Approach
Clinical Outcomes
Lumbar Fusion
XL-TDR Device
Prosthesis Dislocation
Spinal Prosthesis
Oswestry Disability Index
Physical Component Scores
Mental Component Scores
Neurosciences Clinical Institute, Epworth HealthCare, Victoria, Australia
Issue Date: May-2017
Publisher: Elsevier
Citation: J Clin Neurosci. 2017 May;39:176-183.
Abstract: Lumbar total disc replacement (TDR) is an alternative to interbody fusion for the treatment of symptomatic degenerative disc disease. Traditionally, lumbar TDR is performed via an anterior retroperitoneal approach with regional risks of vascular and visceral injury. The direct lateral retroperitoneal, transpsoas approach avoids mobilisation of the great vessels and preserves the anterior longitudinal ligament, thereby maintaining physiological limits on motion. This study aimed to (i) report one site's early experience with lateral lumbar TDR and (ii) provide case examples illustrating the utility, complications and revision strategies of the XL-TDR device. Data were collected prospectively on the first 12 consecutive patients treated with XL-TDR. Patient outcomes included pain (VAS), disability (ODI), and quality of life (SF-36 PCS and MCS). Mean follow-up was 27.5months (range 18-48months). Patients had significant improvements in back (74%) and leg (50%) pain, ODI (69%), PCS (50%) and MCS (39%) (P<0.05). Two patients had early prosthesis dislocation due to prosthesis undersizing. The same skin incision was used to retrieve the XL-TDR and perform salvage lateral lumber interbody fusion, with solid fusion by 12months. Lumbar TDR using the XL-TDR via a lateral transpsoas muscle-splitting approach is a minimally invasive alternative to anterior retroperitoneal exposures for motion preservation. Correct sizing of the XL-TDR and complete contralateral annulectomy with annulus box cutters mitigates the risk of lateral dislocation. Revision surgery for lateral dislocation of the XL-TDR is more straightforward compared to anterior TDR dislocation.
DOI: 10.1016/j.jocn.2017.01.033
PubMed URL:
ISSN: 0967-5868
Journal Title: Journal of Clinical Neuroscience
Type: Journal Article
Type of Clinical Study or Trial: Prospective Study
Appears in Collections:Neurosciences

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